NELFT Sponsored Studies

Open Dialogue: Development and evaluation of a social network intervention for severe mental illness (ODDESSI)

Background

In the NHS there are significant problems in providing care and support for people in a mental health crisis. More people are admitted to hospital than should be, leading to a shortage in psychiatric beds. In principle, community-based crisis teams are effective in managing crises in people’s homes. However, they are not as effective as they could be in preventing hospital admissions due to limited resources and the provision of short term crisis management.

Developed in Finland, Open Dialogue (OD) is a new method for working with people in crisis which works with the service user from initial crisis and beyond, organising treatment and longer term care to prevent crises recurring. In contrast to crisis teams, OD places a greater emphasis on working with the service user, their families and friends, and others (for example healthcare professionals or local community members) to form a network of support. Peer Support Workers (PSWs) are key members of each OD team and each team has at least one PSW to support other team members and assist service users to develop and maintain supportive social networks. There is some evidence from Finland to suggest that OD is an effective way to help people in crisis, but no high quality scientific studies have been undertaken to confirm this.

This research is a five year programme of work to address this evidence gap with five related work packages which aim to investigate whether current NHS services can be re-organised to implement OD and assess whether OD is effective for treating people in crisis.

Work Packages

Development

Adapt, refine and establish the OD intervention for use within existing NHS services (crisis and continuing community care) and assess the implementation of OD and the development of the PSW role. The end result will be a protocol acceptable to clinicians and service users.

Feasibility

Assess the feasibility of conducting a full multicentre cluster randomised controlled trial (RCT) of the OD model.

Multicentre cluster RCT

Comparing Open Dialogue to usual NHS crisis and longer-term community care (TAU) to determine its clinical and cost-effectiveness, with a total of 644 participants.

Process evaluation

To assess adherence to the OD intervention, fidelity to the OD model and to Crisis Care in TAU, OD team function, intervention process, comparison of treatment process in control and intervention groups, staff experience of delivering OD (including PSWs) and training.

Service user and family experience of OD

Explore service user, carer and practitioner experience of OD.

Objectives

This programme has four objectives:

To develop a protocol acceptable to clinicians and service users for the delivery of Open Dialogue (OD) for the management of mental health crisis

To assess the clinical and cost-effectiveness of OD

To understand the experience of service users, carers and staff of OD

To develop a model of OD that can be implemented in routine NHS care.

RADAR

RADAR (Research into Antipsychotic Discontinuation and Reduction) is a research programme led by Dr Joanna Moncrieff and funded by the National Institute for Health Research (NIHR) that aims to provide new evidence on the effects of a gradual programme of antipsychotic reduction and discontinuation in people with long-term schizophrenia and similar conditions. This will support patients and clinicians to make better informed choices about long-term medication.

Background

Schizophrenia is common and costly. The recommended treatment is long-term antipsychotic medication, but many people still find life difficult. Although antipsychotics are effective at reducing psychotic symptoms and relapse in the short-term, they can also have dangerous and unpleasant side effects. Finding alternatives to long-term drug treatment is a priority for patients and services.

Aims

The proposed research aims to test the effects (benefits and harms) of a gradual programme of reducing and discontinuing antipsychotic medication in people with long-term schizophrenia and similar conditions. We want to know whether this approach can help people to function better in their daily lives. Some other evidence suggests this might be the case. We also want to know how it affects the chances of having a relapse. This study will be the first with this group of people that uses a gradual and flexible method of medication reduction, and that follows people up over the long-term.

Objectives

To develop a protocol for a gradual and supported strategy of antipsychotic reduction and discontinuation and to design a trial to evaluate this strategy.

To develop a recruitment strategy for a trial of a gradual and supported strategy of antipsychotic reduction and discontinuation in community mental health services.

To compare the guided strategy of antipsychotic reduction and discontinuation with continuous, maintenance antipsychotic treatment in a six-month internal pilot trial.

To conduct a trial in people with multiple episode schizophrenia or related conditions to evaluate the risks and benefits of the antipsychotic reduction and discontinuation intervention.

EMPOWER

Enabling and Motivating People (with a Personality Disorder) in Occupation, Education and Responsibility is a research study led by Dr Janet Feigenbaum that will evaluate the effectiveness of a 16-week intervention which aims to help people with difficulties consistent with a personality disorder to obtain and retain employment and increase wellbeing.

Background

In January 2013, 1.43 million people in the UK were in receipt of incapacity benefit, many with mental health difficulties. There is a complex relationship between employment and mental health; poor mental health predicts unemployment, whilst employment leads to improvements in mental wellbeing. People with difficulties consistent with a Personality Disorder (PD) may experience intense emotions and have troublesome interpersonal relationships, which can in turn have a negative impact on their wellbeing and capacity for employment. However, pilot studies in the USA have suggested that a modified version of the recommended treatment for PD, Dialectical Behaviour Therapy (DBT), may be effective in in helping people with a PD to obtain and retain employment.

Dr Feigenbaum has developed a 16-week Dialectical Behavioural Therapy Skills for Employment (DBT-SE) intervention. The intervention will target known areas of difficulty for people with a PD such as managing intense emotions, interpersonal relationships, self-criticism and poor self-management and will focus on managing these areas specifically in the workplace and aims to increase employment and wellbeing for individuals with difficulties consistent with a PD.

Aims

The EMPOWER programme aims to develop, evaluate and implement an intervention that will teach participants the skills they need to obtain and retain employment which will result in an improvement in emotional, interpersonal and physical functioning, and will benefit the family and social network of the participant.

Objectives

The EMPOWER programme objectives are:

To increase our understanding of the specific challenges which face individuals with a PD in obtaining and retaining employment.

To develop and evaluate a Preparedness for Employment Scale for individuals with PD (PES-PD), for use in treatment, planning and outcome measurement.

To produce the DBT-SE manual and staff training package.

To evaluate the effectiveness of a brief (16-week) group based psychological intervention; Dialectical Behavioural Therapy Skills for Employment (DBT-SE) with a feasibility study, followed by a full Randomised Control Trial.

To identify if DBT-SE is cost effective compared to existing mental health and employment interventions.

To develop an implementation plan to facilitate the dissemination of DBT-SE in the UK.

To develop a booklet for employers about PD that contains advice regarding reasonable adjustments which service users can give to their managers, Human Resource and/or Occupational Health departments.

To disseminate the PES-PD scale, DBT-SE treatment manual and training package and the scientific results of the EMPOWER study to both specialist and non-specialist audiences.

‘EMPOWER is recruiting participants for WP3, the feasibility study to prepare for the RCT of DBT-SE. If you would like to take part in the study or you are a clinician who would like to refer a client then please contact the study team by calling us on 0300 555 1213 and asking for EMPOWER or by emailing us at EMPOWER@nelft.nhs.uk. If you are unsure please contact us for more information or to speak to us about the study.

Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex: the SPEAKS Study

Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS) is a research study led by Dr Anna Oldershaw which aims to develop a psychological intervention with a focus on working with emotion.

Background:

Anorexia nervosa is an eating disorder that causes people to lose weight and keep themselves at a very low weight by dieting, vomiting, using laxatives or excessively exercising. It affects up to four in 100 people at some point in their lifetime and has the highest mortality rate of any mental health disorder. Anorexia nervosa has poor prognosis and the highest mortality rate of any psychiatric disorder. It is associated with high costs for both the person with anorexia nervosa and their families in terms of burden and suffering, as well as financially to the NHS and economy. NICE guidelines recommend psychotherapeutic interventions for adults with anorexia nervosa; yet outcomes are discouraging. No intervention is shown to be superior to a non-specific clinical control. Targeting unique factors associated with anorexia nervosa and developing innovative therapies is essential. Based on empirical evidence and qualitative interviews, we propose difficulties with experiencing emotion as a development and maintenance factor for anorexia nervosa.

Aims:

We aim to develop a psychotherapeutic intervention targeting difficulties in emotional experience and regulation for adults with AN (Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex; SPEAKS). SPEAKS will focus on a clearly defined model of emotional difficulties and include consideration of therapist supervision needs. We will draw heavily on stakeholder input throughout SPEAKS development and refinement. SPEAKS will be assessed in a mixed-methods feasibility study.

Objectives:

The Objectives follow four phases:

Phase One explores current understanding of facilitators and barriers to change in anorexia nervosa using two qualitative studies, with service users and clinicians, to understand their previous experience of therapy content and techniques. It will explore how to target emotions in clinical practice, alongside therapist effects/needs. Each qualitative study will recruit 12 participants, with data analysed using interpretative phenomenological analysis.

Phase Two will integrate phase one data with the model and a series of focus groups with service users, carers, clinicians and NHS managers to develop the SPEAKS intervention, including a supervision model, described in a therapist guidebook.

In Phase Three, a single-armed feasibility study across two specialist eating disorder services (in Kent and Sussex) will recruit 60 consecutive referrals of adults with anorexia nervosa. All consenting participants will receive SPEAKS instead of psychotherapy as usual, with all other usual care provided. Participants will undergo assessments pre and post-intervention in a mixed-methods design. Post-intervention qualitative interview studies will be triangulated with quantitative clinical and emotion regulation change variables to assess validity and acceptability of SPEAKS. Feasibility will be further addressed using descriptive variables summarising recruitment and attrition rates and adherence to therapy/supervision models. Indication of effect sizes and economic evaluation will be achieved using clinical, intervention-specific and economic outcome measures collected pre- and post-intervention.

Phase Four involves refinement of SPEAKS, revision of the guidebook and if the feedback is positive, we will then seek to run a larger Randomised Controlled Trial comparing this therapy against other therapies to see whether it is more effective. All of our findings will be communicated to policy makers within the NHS and to people with anorexia, their families and therapists via local NHS, support and charity groups.